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Forum Name: Lymphoma

Question: Enlarged Cervical lymph nodes on right side of neck


 LisaLisa627 - Sat Dec 09, 2006 3:10 pm

Hi I am a 41 yr old female who just went to my regular doctor about 2 weeks ago because I had been feeling unwell for about 2 months (I saw him in October for Pneumonia - would get better then get sick again and then just have not felt right) - I have a cough that has not gone away since the beginning of October. It does not feel like a sick cough more like a tickle in my throat (like an allergy) and then I cough and cough and can't stop (or I sneeze a million times) - sometimes cough is so hard that it causes me to vomit. I have about a week or two before I went back to my doctor - woke up and could not breathe out of my nose at all on the right side - felt incredibly congested and had headaches for everyday - finally it appeared it was a sinus infection and I was blowing gross stuff when I could. And then it just kind of went away, but I still just did not feel right. I went to rub my neck and noticed there was a couple of enlarged lymph nodes (I had previous DCIS in left breast so I was concerned) - figured I would watch it and figured it was from sinus, but they did not hurt and I did not really feel sick. They appeared somewhat hard and when I did a search on the internet lymphoma came up. And I did not realize that itching could be a sign of lymphoma - I have had incredible itching - mainly on my hands, but I have had it for at least 5-7 months and it wakes me up because the itch is incredible and I feel it yet cannot get any relief from scratching for long - almost like it is deep inside. Went to my doctor - he felt lots of lymph nodes on the cervical region. I explained all other symptoms and immediately he was concerned about Lymphoma - had chest xray - came back clear. I just had a ultrasound and bloodwork, don't know results of blood work, but the ultrasound measured a couple of the nodes it saw on my right side (did not see any on my left side), but just determined that they was multiple small enlarged lymph nodes in my neck. Hmmmm I knew that! But, they do feel different. I will talk to my doctor on Monday about all this, but I am still concerned that it could be a lymphoma. Can Ultrasounds accurately detect if it were lymphoma or should I still request that I have a CT done?

Thanks for your help!

Lisa
 LisaLisa627 - Sat Dec 09, 2006 3:13 pm

that the U/S impression stated that there were multiple small non-enlarged lymph nodes within the neck.

Sorry for the confusion.

Lisa
 Dr. Tamer Fouad - Sun Dec 10, 2006 2:10 am

User avatar Hello,

CT is more accurate in assessing a case with possible lymphoma, however, it may not be recommended for every case.

If there is strong suspicion of lymphoma then your doctor may decide to persue his investigations further. The gold standard form the diagnosis of a lymphoma is a biopsy. Indeed it is usually after a biopsy confirms the presence of lymphoma that a CT scan becomes essential for staging. For a lymph node to be biopsied it should be significantly enlarged (usually meaning above 1cm).

Wait and see what the blood work tells us. It could either reinforce of decrease the possibility of lymphoma.

Keep us updated. Wish you all the best.
 LisaLisa627 - Sun Dec 10, 2006 10:23 am

Thank you so much for replying.... I just wanted to post what my u/s said:

There is a low-attenuating density identified that appears oval in shape in the right neck measuring approximately 1.1 x .5 x .8 cm. Also appears to be a vascular notch in flow identified centrally with increased echogenicity representing a lymph node. There is a second node identified in the right noeck measuring approx 1.4 x .4 x 3 mm thought to be a node as well. Also appears to be central flow with increased echogenicity centrally. Then they found on the other side (where I do not feel any nodes) a hyperechoic structure identified deep to the strap muscles measuring .8 x .8 cm.

So, the only other thing I wanted to note is that I have been on antibiotics for this in case it was infection and it has not changed the lymph nodes at all. Like I said I have never felt them there before. I am also having some hearing loss on that side with massive nasal congestion on that side, but I don't really feel sick. Also, I have had continuous what sounds like crickets in my head and some ringing. Hard to explain, but noise all the time for about the same length of time since I found the nodes maybe longer.

Thanks, I am definitely calling my doctor. Do you think that he would be willing to send me to a doctor to biopsy the biggest one?

Thanks again!
Lisa
 Dr. Tamer Fouad - Mon Dec 11, 2006 12:41 am

User avatar Hello,

Thanks for the update.

It all depends on his evaluation really. But I think he probably will send you for a biopsy or FNAC.

Let me know.
 LisaLisa627 - Mon Dec 11, 2006 9:00 pm

THank you again Dr. Fouad for answering these questions!

My wbc's were high, but only on the very low end of high suggesting that I did not have anything bacterial, but viral which is why my antibiotics did nothing. They were concerned about the multiple lymph nodes and I am now being referred to an ENT. I am assuming that I will have a biopsy scheduled after I see him. Question? I have had this doctor before and he did surgery on a benign growth in my mouth. He is an excellent doctor, but I am not sure that he is the one that I would want to do my biopsy - not really him I don't trust, but I don't like the hospital he works out of. Any advice on how or what doctor I should have biopsy it if it gets to that?

Does the elevated WBC's suggest even more towards lymphoma with all my other symptoms? I know you may not be able to answer it, I was just curious. I just want to be very proactive if needed.

Thanks again!

Lisa
 Dr. Tamer Fouad - Wed Dec 13, 2006 4:22 am

User avatar Hello Lisa,

Well I think your ENT doctor would have to decide if he wants a CT scan of the head and neck first. The problem with neck nodes is they can be caused by diseases of the head and neck and that should be excluded first before getting a biopsy done.

In such a case its best if it is a surgeon that's specialized in surgery of the neck (eg, oncologic surgeon) unless the nodes are very superficial.

Best regards,
 LisaLisa627 - Fri Dec 29, 2006 12:15 am

Well, he does not seem to be so concerned. He said he did not want to do a CT scan because he felt it would be an unnecessary use of Medical diagnostic testing (or something like that). He said they really only worry when a lymph node was greater than 2 cm. He scoped up my nose and down - only I think because I really pushed for it, but it looked fine - he just noted clear congestion on the right side which is the same side the nodes are on, plus it is the same side that I have some hearing loss as well and the tinnitus is still constant. I don't know he saw my bloodwork or just the u/s. My WBC's were 10800 or 11000. He is having me go back on the 9th to do a hearing test - I had one about 10 months ago to measure some already known about hearing loss in both ears. And he said also that he would biopsy it if it gets bigger, but for me to not lose any sleep over it. Also, said he could send me to a dermatologist for a biopsy of the hands where it is itching so bad. And I have had my lisonopril stopped for almost a week to see if the cough goes away - so far not. The one node I feel the most is still there, I thought it might be getting smaller, but today it seemed a little bigger - I just try and not touch it.

Any advice? I am just thinking that this doctor is not seeing the whole picture and I would rather be proactive and catch something early.

Thanks,

Lisa
 LisaLisa627 - Wed Jan 17, 2007 9:46 pm

Just a little update. I had my hearing test and my hearing is still the same loss I had last year. And my ENT that we should just watch and wait. The lumps at first felt somewhat better, but in the past 2 weeks seem to be alot of nodes there again - and the one is possibly a little bigger. I also found out that my hemoglobing was low - guess that showed up on my bloodwork that I had in November, but the doctor only told me my WBC's were high. I found out when I requested a copy be mailed to me. So, I have made another appointment with my Primary Care doctor - I think he will be more proactive than the ENT. My neck also has an ache on that side in the line of where the nodes are. Nodes are still not painful, but my neck has an ache. I tried to feel my nodes under that arm on the same side and I am not sure if it is muscle or something else. I also still have the cough. I did quit the Lisonpril for awhile now.

Any suggestions?

Thanks!

Lisa
 LisaLisa627 - Thu Jun 21, 2007 2:56 pm

After all of the stuff I posted previously, I had a CT scan of sinuses that showed sinus disease. I went back on Nasocort and my ENT felt that really we could just watch the nodes. I had 2 episodes prior to my last visit with him where they swelled and then went back somewhat normal.... And since have felt good - no sickness, the only thing I can complain about is that I have had continuous and progressive neck tightness on the side where I had the enlarged nodes. So, because of this I have an appt to see my Primary doctor to see if it is anything. I still have the hand itching that is controlled with some prescription cream my doctor gave to me, but when I don't use it - the itch comes back with a vengeance. So, last week I went to the dentist and it has been about 6 years since I have been. As the hygeniest was checking for enlarged nodes in my jaw area (just as check up) she asked me " how long has that been there" and I was like what? And then she let me feel it and I was like OMG.... So, she told me I need to have it checked right away, hopefully it was nothing, but I needed to see my doc right away. I explained I had already had an appt due to the other issue and she said good. I do recall maybe 3 weeks or more ago feeling something really small there, but I just did not even give it another thought and it is much bigger now. It is not on the same side as my previous enlarged nodes it is on my left side, under the ear - kind of in between under the ear and the jaw. It sure does not feel so normal and of course as I have more time to think about it I am getting worried. Any advice? I would guess it is the size of a almond...

Thanks....

Lisa
 annap - Sat Aug 01, 2009 5:18 pm

Hello i have a lump on one side of my neck and it has been there for a few months now. Sometimes i can feel it more then other times and i can feel it more when i tilt or turn my neck to the side rather then when i look straight forward. I think it is an enlarged lymph node.

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